Abstract
ObjectivesThe aim of this study was to identify apparent diffusion coefficient (ADC) values for typical haemangiomas in the spine and to compare them with active malignant focal deposits.MethodsThis was a retrospective single-institution study. Whole-body magnetic resonance imaging (MRI) scans of 106 successive patients with active multiple myeloma, metastatic prostate or breast cancer were analysed. ADC values of typical vertebral haemangiomas and malignant focal deposits were recorded.ResultsThe ADC of haemangiomas (72 ROIs, median ADC 1,085×10-6mm2s-1, interquartile range 927–1,295×10-6mm2s-1) was significantly higher than the ADC of malignant focal deposits (97 ROIs, median ADC 682×10-6mm2s-1, interquartile range 583–781×10-6mm2s-1) with a p-value < 10-6. Receiver operating characteristic (ROC) analysis produced an area under the curve of 0.93. An ADC threshold of 872×10-6mm2s-1 separated haemangiomas from malignant focal deposits with a sensitivity of 84.7 % and specificity of 91.8 %.ConclusionsADC values of classical vertebral haemangiomas are significantly higher than malignant focal deposits. The high ADC of vertebral haemangiomas allows them to be distinguished visually and quantitatively from active sites of disease, which show restricted diffusion.Key Points• Whole-body diffusion-weighted MRI is becoming widely used in myeloma and bone metastases.• ADC values of vertebral haemangiomas are significantly higher than malignant focal deposits.• High ADCs of haemangiomas allows them to be distinguished from active disease.
Highlights
Vertebral haemangiomas are the most common benign vertebral neoplasm with a reported incidence of 10–26 % and are multiple in 7.2 % of normal subjects [1]
apparent diffusion coefficient (ADC) values of vertebral haemangiomas are significantly higher than malignant focal deposits
A region of interest (ROI) was drawn around the haemangioma and the mean ADC calculated for all pixels within the ROI
Summary
Vertebral haemangiomas are the most common benign vertebral neoplasm with a reported incidence of 10–26 % and are multiple in 7.2 % of normal subjects [1]. They are most commonly asymptomatic, rarely (0.9–1.2 % [2]) lesions can cause symptoms through local mass effect, fracture or bleeding [3]. The complement of MR sequences used varies between institutions For some applications such as screening for soft tissue malignancy in high-risk populations, whole-body MRI may consist of whole-body diffusionweighted MRI without T1w and T2w imaging of the spine. In the absence of standard MRI sequences, vertebral haemangiomas may be mistaken for sinister focal deposits
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